Mental Health Matters: Coroners warn of underfunding

HSJ’s fortnightly briefing covering safety, quality, performance and finances in the mental health sector. Mental Health Matters is now written by HSJ’s new mental health correspondent, Rebecca Thomas. Tell her what you think, or about issues she could write about, by emailing her in confidence at rebecca.thomas@wilmingtonhealthcare.com or by sending a direct message on Twitter.

Coroners in Birmingham have raised a warning to NHS England and local NHS commissioners over the funding of mental health services in the area.

During the summer, the senior coroner sent a preventing future deaths report claiming patients are at risk due to “underfunding”.

It’s not the first time coroners in the second city have been vocal about their concerns over mental health. In 2017, the chief coroner sent a report to the Department of Health and Social Care, NHS England and the Care Quality Commission, warning them about the lack of mental health beds across Birmingham.

What was unusual about the latest warning is it was prompted by the deaths of seven patients and sent before all the inquests have concluded.

On Friday, following an inquest into one of the patient deaths, assistant coroner James Bennett told the Birmingham Mail that all eight coroners in the city had begun to see a theme across mental health deaths – a lack of finances and resources.

Birmingham and Solihull CCG, and Birmingham and Solihull Mental Health FT claim they did not identify underresourcing as a factor in any of the seven patient deaths.

However, the mental health trust did not shy away from admitting to an imbalance between the resources it gets and the demand on its services.

“It is the case that the trust is dealing with a high turnover of urgent and complex cases with less acute and urgent care resource compared to other similar mental health trusts,” the provider told HSJ.

Birmingham Women’s and Children’s FT, which runs the area’s struggling CAMHs services, has also chimed in. According to the trust’s September board papers, its medical director was due to send a letter to NHS England and local commissioners “to state that mental health services in Birmingham are under resourced”.

It is always going to be hard to directly link underfunding to a patient death, and we won’t find out for sure until all the inquests are over. However, a lack of resources in terms of staff, particularly in services which are needed for patients in crisis, could have easily had an impact.

Local GP, Bill Strange, described the mental health service in Birmingham as “deeply broken”. For him, there is often “too long a lag” between when a patient is assessed by the crisis or home treatment team and being picked up by the community mental health team.

No doubt the problems arising in Birmingham will be common across the NHS, but the coroner’s warning has given the long-debated issue some extra fire.

To target or not to target

The Daily Telegraph’s report last week that recommendations for a four-hour target were set to be introduced for mental health patients in the long-term plan have neither been confirmed or denied by NHS England.

The recommendation for a four-hour mental health target was first made in Nigel Crisp’s review of crisis care in 2016. In September that year, Tim Kendell suggested this could become a reality by 2021, but NHS England has yet to commit to it.

There is broad consensus that a mental health waiting time target for those in crisis is needed and that this target should bring parity of esteem with physical health equivalent standards.

But the move would also come just as questions are being raised over the clinical efficacy of the four-hour target used in emergency departments. There are suggestions the targets will be ditched for minor injuries.

There would be some merit in considering the conclusions of the targets’ review before any firm decisions were made around a new mental health target. Any new target – and this goes beyond just mental health – would also have to be thoroughly costed.

Then we have the new mental health pathways, which NHS England has yet to publish. So far, the national commissioner has been coy about whether the pathways will include waiting times. In fact, the one pathway which has so far been published, for perinatal services, had the waiting times taken out of the final version.

However, with mental health high on the political agenda and the government needing some good news, there is likely to be more pressure to commit.

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